P628 Patient-reported adherence rates to topical therapies in ulcerative colitis
P. Hendy*1, 2, M. Shuvo3, A. Hart1
1St Mark’s Hospital, Gastroenterology, LONDON, United Kingdom, 2Imperial College, Antigen Presentation Research Group, London, United Kingdom, 3Royal Liverpool University Teaching Hospital, Department of Gastroenterology, 5Z Link Unit, Liverpool, United Kingdom
The mainstay of treatment for mild-to-moderate ulcerative colitis (UC) for both induction and maintenance of remission is 5-aminosalicylic acid (5-ASA). Topical therapies (both 5-ASA and steroid) are included in national treatment guidelines because of their rapid onset of action and local effects. Patient adherence to oral 5-ASA therapy is poor (around 50%), but there are no published studies examining adherence to topical therapy in UC. This questionnaire-based study aimed to establish the rate of non-adherence to topical therapy in UC and to ascertain patient-reported reasons for and demographic factors associated with non-adherence.
A structured interview with patients with UC identified themes related to non-adherence to rectal therapy. A pilot questionnaire, based on these themes, was internally validated. The study questionnaire, incorporating structured patient feedback from the pilot study, was given to consecutive patients with a diagnosis of UC in a teaching hospital gastroenterology outpatient clinic. The study questionnaire collected data on patient demographics and disease and medication history. Common reasons for non-adherence were also recorded (identified in the structured interview and including: difficulty with daily administration, competing priorities, and awkward route of administration).
In total, 122 patients, 59 male and 63 female, were recruited with a median age of 47 years. Amongst the UC patients, 82% had been offered rectal therapy at some point; 7% of respondents had been offered rectal therapy but did not commence treatment. Further, 93 patients had used rectal therapy, of whom 53% were non-adherent. Moreover, 35% of these patients stopped the medication because of difficulty with nightly administration; however, 94% of these patients would have continued to take the medication if there was an option to take it every second or third night. There was a trend towards significance for male gender in non-adherence to rectal therapy (p = 0.07), but other examined factors were not found to be statistically significant.
In the study, 53% of patients did not take rectal therapy as prescribed, of which 35% cited difficulty with daily application as a major factor. Perhaps when prescribing topical therapy, the clinician should emphasise that it is not an ‘all or nothing’ treatment and that pragmatism in frequency of application is reasonable, and indeed important to improve adherence. Although the majority of patients with UC have been offered topical therapy at some point, 18% of patients have not. Clinicians should bear this in mind when considering escalation of therapy in UC, as globally increased use of topical therapy could doubtless reduce the need for escalation to immunosuppressant medications.